[Does tumour diameter still limit the indications for partial nephrectomy in 2008?]

The indications for partial or radical nephrectomy of a kidney tumour are based on tumour diameter with a cut-off of 4cm. Tumour diameter has been demonstrated to be a continuous prognostic parameter which, ideally, should be integrated into multivariate prognostic models. The 4cm cut-off is reasonable, but was established pragmatically on the basis of series comprising selection biases. At least six series now question the validity of this cut-off, and some of them have demonstrated that partial nephrectomy and radical nephrectomy are equivalent in terms of cancer control for pT1b tumours. Furthermore, the excess mortality induced by broader indications for partial nephrectomy appears to be acceptable. These data appear to suggest that the feasibility of partial nephrectomy should be considered regardless of tumour diameter before proposing the indication for radical nephrectomy.